End of Life Care Profile on Fingertips 23 May 2017 Jo Wall Principal Knowledge Transfer Facilitator South East Local Knowledge and Intelligence Service

Fingertips suite of tools (fingertips.phe.org.uk) Most of the tools produced by PHE can be found by starting on this website. Can find it just by googling fingertips or enter the url: fingertips.phe.org.uk

Fingertips Home Page This is the Fingertips home page. If you get stuck, there is a user guide. If you have any queries or feedback, if you click on contact us you can send an email direct to the Fingertips team. There are lots of different profiles which mainly follow the same format/structure. 2. To view the End of Life Care Profile just click on the link.

End of Life Care Profiles – Home Page The profile home page provides information about the profile and details of recent updates. Click on the start button to take you to the data.

Getting Your Bearings 1. The row of tabs at the top correspond to the different domains of the profile. By clicking on these you can change which domain you are exploring. 2. The second row of tabs correspond to the different ways in which indicators can be displayed, the different views of the data. We will move onto this in a moment. 3. The group of dropdowns below this allows the user to change which geography they are looking at. Depending on the indicator you can view data by CCG, local authority or strategic clinical network. For CCG geography you can group by sub-region, SCN, deprivation decile (only one at a time), ONS clusters, CCG clusters and STP. You can also change the benchmark depending on how grouping areas – England, SCN, sub-region, deprivation deciles etc. In this example CCG is selected as the area type, grouped by SCN and Wessex has been chosen as the SCN. The specific CCG selected is Dorset CCG. 4. Here is the key for the benchmarking. Most profiles/indicators within Fingertips use the red/amber/green RAG rating to represent significantly worse/better but for the End of Life Care profiles light blue/amber/dark blue is used to represent significantly higher/lower than the chosen benchmark – i.e. no value judgement given as to polarity. Public Health Outcomes Framework data tool

Overview Tab Here is the “Overview” tab which allows the user to look at a “tartan rug” of the data. This provides an overview of all the indicators within the selected domain for all CCGs in the selected geography, benchmarked against the chosen comparator. In this example we are looking at the “Death in Usual Place of Residence” domain. So, in this case we can see that the majority of CCGs in Wessex are benchmarked as either significantly higher or similar to England across all indicators. 1. The name of the indicators are down the side 2. The CCGs are along the top. 3. Can export table as image.

Map Tab The map tab provides a geographical view of the data for the selected indicator. You can change the indicator using the drop down arrow in the grey geographical area box. By hovering over an area on the map, the name of the CCG and associated value pops up and the value is highlighted on the graph. Alternatively, hovering over the graph brings up the name and the value of the CCG and also highlights the CCG on the map. By clicking on the CCG on the map, the value becomes selected in the table. You can add multiple CCGs to the table if you wish. Look other mapping tools there is the ability to zoom in and out on the map using the plus and minus buttons, and also to add different layers e.g. roads or satellite, using the staked paper icon. You have the ability to change the way the data are colour coded in the map from the “Map colour” drop down. The current view shows the values for each CCG benchmarked against England. You could also have the areas coloured by quartiles, quintiles or have a continuous scale. Public Health Outcomes Framework data tool

Trends Tab 1. The Trends tab enables you to view historic data (where available) so you can examine trends. 2. You can view the selected indicator or all indicators in the chosen domain for a particular CCG. 3. Or you can view trend data for all CCGs within the selected SCN for the selected indicator. 4. You can add confidence intervals for each time period. This gives an indication of whether changes between years are significant (when CIs don’t overlap). Public Health Outcomes Framework data tool

Compare Areas Tab The compare areas tab enables presents a benchmarked bar chart view of a selected indicator for all CCGs in the selected geography. You can change the indicator (only those within the domain you are in) by using the drop down arrow. By default, the CCGs are ordered alphabetically, but this can be changed to either ascending or descending indicator value. Clicking on the name of a specific CCG takes you to the “area profiles” tab (see next slide). Sometimes a funnel plot will also be shown (if available). Public Health Outcomes Framework data tool

Area Profiles Tab 1. The area profiles tab shows a spine chart of the indicators within the selected domain for the selected area (in this case the Death in usual place of residence domain and Isle of Wight CCG). 2. A spine chart has the England value centred at the red line, with the selected area value presented relative to this. The light grey box is the range of values for England, while the dark grey box is the inter-quartile range (middle 50% i.e. 25th percentile to the 75th percentile). This visual representation of the data allows a lot of information to be taken in with a quick glance. 3. The selected area value is represented by a circle – coloured according to how the value compares to the chosen benchmark. 4. This view also provides you with the indicator values for the selected area, the SCN and England. 5. The lowest and highest values in England are also shown – this gives you a sense of the numerical range. Clicking on the name of an indicator takes you back to the “compare areas” tab (see previous slide). Public Health Outcomes Framework data tool

Definitions Tab The definitions tab contains data metadata for all published indicators grouped by domain. You can select the required indicator from the drop down arrow. Important to check definitions carefully to ensure the indicator is actually measuring what you think it is! Public Health Outcomes Framework data tool

Download Tab 1.The download tab allows users to download the data and definitions for the whole profile, domain or specific indicator, either for all CCGs in England or those in the selected SCN. Public Health Outcomes Framework data tool

EoLC Profiles – indicators by domain(1) % of deaths in hospital, care home, home, hospice, other place Split by age group: All ages, 0-64, 65-74, 75-84, 85+ Place of death % of deaths in usual place of residence by age group: All ages, 0-64, 65-74, 75-84, 85+ % of deaths in usual place of residence for all ages by cause of death: cancer, circulatory disease, respiratory disease, dementia & Alzheimer’s disease Deaths in usual place of residence (DiUPR)

EoLC Profiles – indicators by domain(2) % of deaths from the following causes: cancer, circulatory disease, respiratory disease Split by age group: All ages, 0-64, 65-74, 75-84, 85+ Underlying cause of death % of all deaths by age group: 0-64, 65-74, 75-84, 85+ Directly age standardised mortality rates by age group: All ages, 0-64, 65-74, 75-84, 85+ Mortality

EoLC Profiles – indicators by domain(3) Care home beds per 100 people aged 75+ Nursing home beds per 100 people aged 75+ % of deaths in care homes where the care home is not the usual place of residence (temporary residents) Care home use at end of life Dementia recorded prevalence: all ages, 65+ Directly age standardised rate of mortality in people with dementia Place of death for people with dementia - %s in usual place of residence, hospital, home, care home Dementia & Alzheimer’s disease

EoLC Profiles – indicators by domain(4) Permanent admissions to care homes per 100,000 by age group: all ages, 18-64, 65+ Delayed transfer of care Excess winter deaths Deprivation: Index of Multiple Deprivation (IMD), Income Deprivation Affecting Older People Index (IDAOPI) Total resident population % of population aged 65-74, 75-84, 85+ Relevant indicators from other profiles

Search Function The search function on the home page is useful if you don’t know what indicators are available for a certain topic or which profile/tool they are in. For example searching on “care homes” returns the following….

Search Results Any relevant indicators will be shown in the Overview view. The results will tell you how many relevant indicators there are for each geography level. It will also show you which profiles each indicator is located in. Note that the results might not appear in relevance order. The search function looks at the metadata info not just indicator name.

Tips Check your top line - what set of indicators (domain) are you looking at? Check the second line - what are you doing with the data (map, compare etc.)? Check your area type (CCG, County & UA or District & UA, STP etc.) is correct Consider which benchmark you are using (England or Region/Sub-region) If you are looking at a single indicator – re-check it’s the right one and read the definition

Other sources of end of life data

National General Practice Profiles Another profile on the Fingertips platform. Under the “Other Conditions” topic in the bar chart view – shows the variation in QOF prevalence for palliative/supportive care (number of patients on the palliative care/support register divided by the total number of registered patients) by GP practice for a selected CCG (in this case Portsmouth).

End of Life Care Atlas of Variation - coming soon…… Indicators split into following categories: demand, hospital setting, care homes, home care and hospice care Indicators from the care homes category: Deaths in a care home; percentage of all deaths by CCG Care home population; as a percentage of the adult population Care home bed rate; total beds in care homes as a ratio to total population aged 75+ by CCG Nursing home bed rate; total beds in care homes with nursing as a ratio to total population aged 75+ by CCG Percentage of deaths of care home residents that occur in a care home by CCG Percentage of deaths in a care home who are temporary residents by CCG Will be available on the Fingertips platform later this year PDFs Data spreadsheet

Slide taken from the “Introduction to the Atlas of Variation - End of Life Care Webinar held by the PHE Clinical Epidemiology team on 22 February 2017 The column chart displays the values for all CCGs for the most recent time period. 5 colour shades are used according to how the values compare with the England value. Significance is now tested at the 99.8% level as well as the more common 95% level.

Slide taken from the “Introduction to the Atlas of Variation - End of Life Care Webinar held by the PHE Clinical Epidemiology team on 22 February 2017 The map view provides a geographical view of the data, with CCGs coloured according to how they compare against the England value.

3 or more admissions in last 90 days Range (Max-Min) 95th – 5th percentile Interquartile range Median Slide taken from the “Introduction to the Atlas of Variation - End of Life Care Webinar held by the PHE Clinical Epidemiology team on 22 February 2017 This trend box plot view is new and provides useful information about the distribution of CCG values over time. Median Interquartile range – middle 50% of values 95th minus 5% percentile – middle 90% of values. Range – Maximum minus minimum Trend info – direction and statistical significance.

Thank You jo.wall@phe.gov.uk 07909 533573